PROJECT SUMMARY Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionally affected by the HIV epidemic. Pre-exposure prophylaxis (PrEP), if used daily, can reduce the number of new HIV infections among AGYW. The multi-level factors that influence PrEP adherence and persistence among AGYW, however, are understudied. The proposed research?Picture Me HIV Free: Using Photovoice to Identify Factors Shaping PrEP Adherence?will use Photovoice, an established community-based participatory research method, to identify salient multi-level factors that influence adherence and persistence to PrEP among AGYW. We will partner with a PEPFAR-sponsored DREAMS Initiative program that provides AGYW access to PrEP in Kisumu, Kenya. Participants in the proposed research will take photographs and write captions to describe the context of the images in the photographs. Using this approach, participants record, reflect, and discuss the personal and shared realities surrounding HIV prevention that are salient within their communities and shape their day-to-day lives. In Aim 1, we will identify and describe multi-level factors that affect adherence to PrEP among AGYW through using Photovoice with AGYW enrolled in DREAMS who have initiated PrEP, AGYW who have not initiated PrEP (peers), male partners and male peers, family members, and community members, including healthcare providers. Participants will engage in intra-cohort discussions (where a single study population, e.g., AGYW who have initiated PrEP, meet to share and discuss their photographs and perspectives) and inter-cohort discussions (where two study populations, e.g., AGYW and community members, share and discuss their photographs and perspectives). In-depth interviews with AGYW who have initiated PrEP will follow to determine how the broader level factors that were collectively identified during the Photovoice discussions influence individual behavior. Using a similar process, we will engage the same population groups in Aim 2 to identify and describe the multi-level factors that affect persistence to PrEP, including ?seasons of risk?, among AGYW. By identifying and describing factors from multiple levels of AGYW?s social ecology that influence PrEP adherence and persistence among AGYW, we will be equipped to identify and position components of future interventions in areas that matter most in supporting adherence and persistence to PrEP among AGYW. We will then develop and evaluate the intervention as part of future research.